Managing the COVID-19 Pandemic as a National Radiation Oncology Centre in Singapore

Abstract

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a global pandemic in March 2020. It has impacted the world medically, financially, politically and socially, with countries such as China and Italy adopting a full lockdown of their cities to mitigate the transmission. The current mortality rate is 5.4%, with 1 056 159 people infected worldwide. The disease is reminiscent of SARS in 2002, from which the healthcare system of Singapore has garnered many lessons and applied them in the current climate. As a result of the high transmissibility of the virus, hospitals in Singapore have reduced clinic loads and elective treatments to halt propagation of the virus and also to allow redistribution of healthcare workforce to the frontline. Cancer patients, who are often immunocompromised, are at risk of contracting the disease and becoming seriously ill. At the same time, delaying treatment such as radiotherapy in cancer patients can be detrimental. Here, we describe our experience as a large radiation oncology department in Singapore, including the challenges we encountered and how we managed our patient flow.

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

“… c) Tumor bleeding d) SVCO or airway obstruction a) Brain: 20 Gy / 5 frs b) Spinal cord and bone met. : 8 Gy/ 1 fr c) 3·7 Gy / 4 twice daily fractions or 4 Gy / 5 daily fractions d) 8·5 Gy / 2 weekly fractions or 4 Gy / 5 daily fractions Canada ( Hahn et al, 2020 ) ✓ a) Tumor bleeding b) Other Palliative RT regimen a) 8 Gy / 1 fr b) 8 Gy in 0-7-21 (3 days) regimen (ensuring the final fraction is off-cord and brainstem) Iran ( Aghili et al, 2020 ) ✓ - 8 Gy/ 1 fr - 20 Gy/ 4 frs France ( Belkacemi et al, 2020a ) ✓ 20 Gy / 5 frs 20 Gy / 4 frs Canada ( Rathod et al, 2020 ) ✓ 20 Gy / 5 frs 30 Gy / 10 frs a) Stage IV NSCLC b) Extensive stage (III-IV) SCLC a) 8-10 Gy / 1 fr b) 8 Gy / 1 fr Singapore ( Tan et al, 2020 ) ✓ 20 Gy / 5 frs 30 Gy / 10 frs 8 Gy / 1 fr USA ( Chaves et al, 2020 ) ✓ Locally advanced HNSCC - 24 Gy / 3 frs (D0-D70D21) - 25 Gy / 5 frs - QUAD SHOT technique: 3·7 Gy bid given over two consecutive days, a total dose of 14·8 Gy per cycle, each cycle every four weeks Italy, Switzerland ( Banna et al, 2020 ) ✓ Lung - 8-10 Gy / 1 fr - 17 Gy / 2 frs USA, France, China, Spain, the ...…”

The Effects of COVID-19 on Cancer Care Provision: A Systematic Review

“…Testing played a huge role in various studies, with many hospitals enabling patient screening for COVID-19 symptoms upon hospital entry or pre-operatively. 3 , 7 - 38 This involved recording body temperature, checking respiratory symptoms, and taking blood tests and nasal swabs. 3 , 10 , 11 , 22 , 33 , 34 , 36 , 39 If the tests results were positive, patients were either disallowed treatment, asked to isolate/quarantine or were directed to COVID-19 outpatient clinics/admitted in to dedicated COVID-19 wards.…”

“…19 Videoconferencing was also frequently utilized between healthcare staff and multidisciplinary teams in order to streamline healthcare provision, continue staff training and maintain timely diagnosis and treatment. 7,11,17,19,30,33,35,36,40,41,45,49,51 Silvestris et al 35 P P P P P Tagliamento et al 25 P P Tan et al 7 P P P P P Tey et al 10 P P P P Valenza et al 37 P P P P Van de Haar et al 3 P P P P P van der Lee et al 64 P Vanderpuye et al 40 P P P P P Wahed et a 28 P P P Wang et al 34 P P P P P Wakefield et al 20 P P P P Wei et al 71 P Weisel et al 8 P P P P P Wilkinson 42 P P P P P Wilson 30 P P P P P Wu et al 44 P P P P Yusuf 13 P P P P P Agyapong et al 52 Report Canada 1. Trailed providing self-subscribed supportive message to reduce anxiety and depression in cancer patients Ardizzone et al 75 Report USA 1.…”

Early Outcomes of a National Cancer Center's Strategy Against COVID-19 Executed Through a Disease Outbreak Response Taskforce

“…Judicious clinical resource allocation and adaptations of standard-of-care treatment regimens by our clinicians [23][24][25] enabled us to continue to provide timely cancer-related surgeries, chemotherapy, and radiation treatments during the COVID-19 pandemic. Our risk-stratified plan was later found to be in alignment with principles outlined by oncological management guidelines for the COVID-19 era by professional societies and expert consensus.…”